The association between knowledge, attitude and mental health status toward exclusive breastfeeding among mothers attending maternal and child health clinic in Gombak / Siti Saleha Abdul Rani

Breastfeeding is universally considered as the best feeding practice for infants. Optimal feeding is crucial during the first two years of life for promotion of good growth, health, and behavioural development. The Malaysian Breastfeeding Policy was revised in 2005 in accordance with the 2002 World Health Assembly Resolution 54.2, following the recommendation by the World Health Organization that all infants should be exclusively breastfeeding (EBF) from birth to six months of age, followed by the gradual introduction of other forms of nutrition; breastfeeding should then continue into the second year. Despite the well-recognized reputation of EBF, the practice is not widespread either globally or even in Malaysia. Knowledge and attitude are important modifiable factors influencing EBF practice. Maternal mental health has major impacts on breastfeeding (BF), growth and health of the child. This was a cross sectional study conducted between March to June 2018 involving 400 women with infants aged six months old from two selected government health clinics in Gombak, Malaysia. Data was collected via interviewer guided using two sets of questionnaires comprising of Malay version Knowledge and Attitude BF Questionnaire (KA-BFQ) and Depression, Anxiety, Stress Scales (DASS) questionnaire. The result of the study shows that the rate of EBF among mothers was 62.0%. The mothers are ranged between 19 to 47 years with a mean age of 30.58 ± 4.85 years. Majority of the women were of Malay ethnicity (81.8%) were married (99.3%) with tertiary educational level (53.5%). More than half of the women were working mothers (60.5%) and it’s significantly associated with EBF. Majority of the mothers were knowledgeable about BF and having positive attitude toward EBF. Both knowledge and attitude items among EBF mothers were significantly higher compared to non-EBF mothers. Using DASS questionnaire, the prevalence of the stress was 12.0 % (95%CI: 8.8, 15.2), anxiety was 27.0 (95%CI: 22.6, 31.4) and depression was 11.8 % (95%CI: 8.6, 14.9). The logistic regression model showed that predictors of EBF was associated with maternal occupation status, maternal knowledge and attitude toward EBF. Measures to improve breastfeeding practice rate should be focused on addressing misconceptions and negative attitudes toward EBF by Ministry of Health. Adopting facilitator measures at work place could increase the rate of EBF. Strengthening of baby-friendly hospital initiative by encouraging early initiation of BF are needed to ensure the sustainable EBF journey. 2